Recently, it was 2:00 a.m., and sitting across from me in the Emergency Department was a near mirror image of myself: it was a young man, presenting with chest pain. 

“Doc, it feels like an elephant is sitting on my chest!,” he exclaimed.

As I received the lowdown from the Emergency Department team, the young man is deemed not to be in immediate danger. His initial labs look normal, and his heart strips (EKG) showed some very mild changes. 

“Are you sure this isn’t the heart?” I asked the presenting provider.

“No way! He is 32!” the provider replied.

I wasn’t satisfied with his answer. Doing my due diligence, I treated this young man like a heart attack patient, giving him the usual cocktails of medications, and his symptoms began to improve. The following day, he was given a stress test, which indicated low blood flow to the heart. He was immediately whisked away to the cath lab, where he received a stent for a blockage of one of the main arteries in his heart—the one aptly termed “the widow maker.”

‌‌‌‌Men And Heart Disease, The Number One Killer

Heart disease remains the number one killer of Americans and the incidence of heart disease continues to rise. The risk of heart disease is much higher in men than in women, affecting about one out of every 3-6 men.

And if that wasn’t scary enough, more than half of men had no symptoms before their heart disease was diagnosed, and the numbers don’t even count those that died of “sudden causes.” So, the question is, why do men get more heart disease than women do?

16 Natural Remedies for a Healthy Heart: Read more.

‌‌‌‌Are Hormones The Cause Of Heart Disease In Men?

When comparing men versus women, the biggest difference between them is hormones. Men and women have variable estrogen, progesterone, and testosterone levels. Estrogen and progesterone are more dominant in men, and testosterone is more dominant in men. These hormones are responsible for sex drive, yes, but they do many other vital functions in the body like regulating bone density, energy levels, and muscle mass.

One such role that testosterone plays is related to the heart. Testosterone can cause your blood vessels to relax in the right places, like the heart. In terms of electrical activity in the heart, testosterone helps to stabilize potassium channels in the heart. The big T can also help to reduce damage to the heart when a heart attack does occur.

Given this information, one can assume that testosterone is good for the heart. Does that mean estrogen and progesterone are bad for it? No! estrogen also offers protection for your blood vessels, improves cholesterol signaling, and lowers the risk for clots to form in your arteries, which are all critical factors in heart disease.

So, as men, then where does the dysfunction occur in our hormones? The answer lies in the way hormones are created. To make our sex hormones, we have to take in adequate amounts of fat and cholesterol. These fats convert into testosterone, estrogen, and progesterone—the amount produced is based upon the tissue, sex of the person, and age, among other factors.

‌‌‌‌Insulin Resistance And Heart Disease In Men

One other important factor in heart health is the interplay of adipose tissue (body fat) and insulin. As our average body fat percent rises in America, so do our rates of insulin resistance. This means that when you have constant influxes of high sugar (glucose) in the blood, your body releases insulin to reduce it, driving glucose into the cell.

Eventually, the cell gets packed full of glucose (which converts into adipose or fat), and there is no room for more. Add on another big bowl of pasta, and your blood sugar remains high, leading to more insulin release from the pancreas. This cycle continues until your tissues stop listening to the insulin response, the pancreas burns out, and congrats, you are now insulin resistant.

Insulin resistance actually will shift your sex hormones away from the “good” guys like testosterone and toward the “bad” stress hormone cortisol (more of that later). This shift is the “pregnenolone steal.” 

How To Resist Insulin Resistance

Though insulin resistance necessitates an article or two by itself, in brief, you can limit your resistance by eating lots of fiber, mostly from vegetables. Also, the impact of your food on your pancreas and insulin level, defined as the glycemic index, matters too. Generally, you should choose foods with a low glycemic index (low insulin response), like non-starchy vegetables.

You also can switch from using carbohydrates to ketones as fuel either via the ketogenic diet, a high fat, low carb diet) or by intermittent fasting. Finally, supplements like berberine may help modulate your body’s insulin sensitivity.

What Is The Keto Diet? A Doctor Breaks Down Everything You Need To Know: Read more.

‌‌‌‌Aromatization And Heart Disease In Men

Other than insulin response and the pregnenolone steal, men with lots of belly fat can shift testosterone toward estrogens via the enzyme aromatase. Aromatase is necessary, but when more belly fat is in the mix, the volume of these enzymes skyrockets. Aromatization can cause men to gain weight and via the above mechanism of action, also cause insulin resistance. 

You can shift your hormones back to normal testosterone levels by inhibiting aromatase via foods like:

There are also some supplements that may help to block aromatase, such as:

‌‌‌‌Cortisol, Stress, And Heart Disease

Now back to our “bad” guy cortisol. High cortisol levels will cause further insulin resistance and weight gain and elevate your blood pressure and heart disease risk. Cortisol also will narrow your blood vessels directly, and interfere with sleep and your ability to cope with stress. As far as heart disease for men, stress is the key, not the hormones themselves.

A study from 2016 in JAMA evaluated risk factors among men and women in Norway who developed cardiovascular disease. The number of men with heart disease was twice that of women. In this study, they concluded that changes in hormone levels did not impact heart disease risk. So, perhaps it is not the hormones themselves, but rather the effect of these hormones on the stress response. Further research has suggested that differences in men’s and women’s stress response may be a primary factor, which means that we have room to make an impact. 

‌‌‌‌How To Manage Stress And The Impact Of Cortisol

One of the most valuable changes that I have made to my daily routine is incorporating a mindfulness practice. Meditating every day is easy to implement, takes as little as 5 minutes, and the most challenging part is learning to do nothing. To further prove that meditation can positively impact our hearts, an analysis of studies from the American Heart Association from 2017 demonstrated lower blood pressure and stress, and higher rates of tobacco cessation with meditation.

Given that the stress response is a considerable risk factor for heart disease in men, the potential to positively impact your heart disease risk appears robust. Now that there are so many apps designed just for meditation, you can quickly get started right now in the comfort of your own home.

Health Benefits of Meditation: Read more.

Other ways to manage stress include prioritizing sleep, which will also significantly impact cortisol’s effect on your heart. Meditation also helps with sleep. but there are many other things you can do to improve the quality of your rest, including:

  • Sleeping in a room that is 60-65 degrees Fahrenheit
  • Making your room as dark as possible
  • Minimizing blue light exposure
  • Journaling as a tool for stress management 
  • Taking supplements that promote relaxation, like melatoninL-theanineGABA, and magnesium


I hope that this information has helped you guys out there who are concerned about your hearts. And the most important thing to remember is to see a doctor if you have any symptoms immediately. Your life may depend upon it. You can quickly implement minor changes to impact your hormones and your stress response for the rest, which will help to keep your heart healthy.